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Can You Do Me A Solid?

I rarely ever have a solid bowel movement anymore. It's almost like diarrhea all the time for me. What's going on? Am I sick?" — James F., Baltimore, MD

Any consistent change in bowel habits deserves a checkup with your primary care provider. Although most of the changes can be attributed to things like a change in diet, chronic diarrhea can be a sign of a fixable abnormality. Infections of the bowel can cause watery stools; parasites like "Giardia" live in mountain streams and are easily treated. Your provider will likely do a "stool for parasites" test. This is a fun test wherein you defecate into a jar and bring it to the lucky lab tech for microscopic examination. They can also do a culture to look for "bad" bacteria. Another test that can be done is a "stool for fat", which looks for malabsorption which can be caused by disorders of the pancreas and other "auxiliary" GI organs. Globs of fat (or oil seen floating in the toilet water) is an indication that something has gone wrong in the absorption department of the gut.

If nothing comes up in the stool studies, your provider can do a "urine for indicants" study, looking for bacterial overgrowth in the bowel that can cause irritable bowel symptoms. A probiotic supplement may be in order if this is the case. If it's associated with dairy products, you may be lactose intolerant. Supplementing your diet with the lactase enzyme (the protein that breaks down sugars found in milk) will correct the problem. If it's associated with eating wheat, your provider will test you for "celiac disease," which is a vastly under-diagnosed problem in the world. The best treatment for it is a "gluten free" diet.

In the end (no pun intended), a colonoscopy may be indicated. If nothing shows up anywhere, then you'll fall into a box with millions of other people in the world...the catchall diagnosis of "Irritable Bowel Syndrome", or IBS.